International journal of epidemiology最新文献

Background: We investigated heterogeneity in cognitive aging trajectories in rural Malawi-a low-income country in sub-Saharan Africa in which the current understanding of cognitive aging is limited.

Methods: We used longitudinal data on 1214 adults aged ≥45 years from the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health from 2012 to 2022 and employed latent-class trajectory models to identify distinct trajectories of cognition. We estimated associations between sociodemographic variables and group membership probabilities by using fractional multinomial logit regression models.

Results: Three cognitive trajectory groups were identified: 36% of the respondents belonged to the "high" cognition group characterized by a stable relative decline in cognition over time, 46% belonged to the "medium" cognition group experiencing intermediate relative decline by age 80 years, and 18% of respondents belonged to the "low" cognition group experiencing the largest relative decline in cognition by age 80 years. Individuals on higher cognition trajectories were more likely to be men, have completed a primary or secondary level of schooling, be living in a house with a metal roof, and have been born in younger cohorts.

Conclusion: Heterogeneity exists in cognitive aging trajectories in Malawi-while some individuals experience healthy cognitive aging, a nontrivial subgroup also experience accelerated cognitive decline over the life course. The results provide guidance for policymakers and practitioners in developing targeted programs to prevent or reduce the burden of cognitive decline among high-risk groups and seek to enhance healthy cognitive aging among older adults in Malawi, where resources for treatment and care are limited.

Background: The stepped-wedge cluster randomized trial (SW-CRT) is a pragmatic complex design that can be difficult to implement. We aimed to summarize the reported problems and responses to problems in studies recently published after the publication of the reporting guidelines for SW-CRTs.

Methods: We searched the literature for SW-CRTs published between 9 November 2018 and 23 February 2021 to identify reported SW-CRT-related problems (defined as relating to the components of the design, i.e. involving clusters and the staggered intervention implementation) and responses to problems. We carried out a thematic analysis to derive descriptive themes and overarching analytical themes.

Results: Among 84 included SW-CRTs, 62 (74%) reported 107 problems related to the SW-CRT design and 38 responses to 36 problems were reported by 24 trials. The "problems" formed six descriptive problem themes: "participant recruitment," "cluster issues" (e.g. cluster merger or dropout), "internal factors" (e.g. logistic or administrative issues), "external factors" (e.g. weather or religious events), "outcome measurement" (e.g. practicalities around measurement of repeated outcomes), and "intervention implementation" (e.g. delays or contamination). The "responses" formed six descriptive themes: "adding new clusters," "modifying the randomization," "reducing contamination," "changing outcomes," "intention-to-treat," and "modifying the analysis."

Conclusion: SW-CRTs commonly run into problems. Two overarching and conflicting analytical problem themes emerged: the "struggle to adhere to the protocol," given the defining features of the SW-CRT design, when faced against "real-life pressures" created by internal and external factors. Further research is needed to explore whether responses to these problems have resource or integrity ramifications.

Background: In sub-Saharan Africa, sexually transmitted and reproductive tract infections (STIs/RTIs) are important but underdiagnosed risk factors for adverse pregnancy outcomes. Sulfadoxine-pyrimethamine (SP), used for the intermittent preventive treatment of malaria in pregnancy (IPTp), may reduce the STI/RTI burden due to its antimicrobial activity. We assessed the impact of IPTp regimens on STI/RTI prevalence and evaluated associations between STIs/RTIs and adverse birth outcomes.

Methods: We conducted a secondary analysis of a randomized-controlled trial comparing monthly IPTp with SP, dihydroartemisinin-piperaquine (DP), or DP+SP among pregnant women in Uganda. Vaginal swabs collected at or near delivery were tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Group B Streptococcus (GBS) by using GeneXpert; bacterial vaginosis was assessed by using Nugent scoring. Log-binomial regression was used to compare STI/RTI prevalence between IPTp arms; IPTp-DP served as the reference arm. Multivariable Poisson regression with robust standard errors was used to evaluate associations between infections and preterm delivery, term low birthweight (LBW), overall LBW, and small-for-gestational age.

Results: Among the 2265 participants assessed, the IPTp-SP arm had an 80% [95% confidence interval (CI): 67%-88%] lower prevalence of C. trachomatis (2.5% vs 12.4%) and a 35% (95% CI: 1%-57%) lower prevalence of GBS (7.7% vs 11.7%) at delivery compared with the IPTp-DP arm. Chlamydia trachomatis was associated with increased preterm delivery [prevalence ratio (PR) = 1.86, 95% CI: 1.07-3.25] and GBS was associated with increased term LBW (PR = 2.08, 95% CI: 1.06-4.08).

Conclusion: Monthly IPTp-SP may reduce the risk of adverse birth outcomes through its activity against C. trachomatis and GBS, highlighting its potential non-malarial benefits.

Introduction: The relationship between kidney cancer and occupational exposures, especially agricultural, has been understudied. This study aimed to assess the risk of kidney cancer with a wide range of agricultural activities and tasks.

Methods: Participants from the French AGRIculture and CANcer cohort (≈180 000) were included. Incident kidney cancers (n = 654) were identified through cancer registries from 2005-2007 until 31 December 2017. Occupational exposures and potential confounders were identified by using enrollment questionnaires covering 5 livestock types, 13 crops, and related tasks. Cox models with age as the timescale were applied separately for men and women, using non-exposed farmers as the reference to account for genetic and agricultural exposure differences, along with exposure-response and sensitivity analyses.

Results: In men, positive associations were found between kidney cancer risk and working with rapeseed [hazard ratio (HR) = 1.26 (0.95-1.68)] and sunflowers [HR = 1.23 (0.89-1.68)], and tasks related to other crops such as corn, wheat/barley, beet, and tobacco. In women, an increased risk was noted for winegrowers [HR = 1.56 (1.12-2.18)]. Pesticide use (on fields and/or seeds) was associated, for both sexes, with these crops, showing exposure-response relationships with crop area and work duration. Conversely, some inverse associations were observed for livestock breeding, notably cattle in men and poultry in women.

Conclusion: We reported positive associations between kidney cancer risk and specific field crops, tobacco, and vineyards, with gender differences in pesticide-related tasks. Further studies are needed to understand these differences and identify substances linked to kidney cancer.